Vitamin D regulates cell viability, migration and proliferation by suppressing galectin-3 (Gal-3) gene in ovarian cancer cells.

Vitamin D deficiency is identified as a risk factor for the occurrence and recurrence of ovarian cancer. Galectin-3 (Gal-3) participates in many physiological and pathological processes. In present study, serum vitamin D level was detected using chemiluminescence enzyme immunoassay. Gal-3 expression was examined using real-time polymerase chain reaction (PCR), Western blot and immunocytochemistry analysis. SKOV3 cells viability was assessed by the water-soluble tetrazolium salt (WST-1) assay, the migration of SKOV3 cells was detected using transwell assay, and the proliferation of SKOV3 cells was measured by 3H-thymidine incorporation (3H-TdR). Our study demonstrated that vitamin D levels were lower in 40 ovarian cancer patients: vitamin D deficiency is closely related to the pathogenesis of ovarian cancer. Treatment with vitamin D reduced the migration and proliferation of ovarian cancer cells. Gal-3 was overexpressed in ovarian cancer, which could induce the viability, migration and proliferation ability of ovarian cancer cells, and these effects were abrogated by vitamin D downregulating the expression of Gal-3 gene. Therefore, our results support that vitamin D may suppress Gal-3-induced viability, migration and proliferation ability of ovarian cancer cells, which suggests that the use of vitamin D may have beneficial effects in preventing and treating ovarian cancer.

[Mucinous cystic liver tumors: diagnosis and surgical treatment]. / Mutsinoznye kistoznye opukholi pecheni: diagnostika i khirurgicheskoe lechenie.

AIM: To optimize diagnostics and treatment of cystic liver tumors. MATERIAL AND METHODS: The analysis included outcomes of 46 patients with liver cystic tumors. RESULTS AND DISCUSSION: The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium. CONCLUSION: There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.

Can CA-125 predict lymph node metastasis in epithelial ovarian cancers in Turkish population?

OBJECTIVE: The role of single preoperative serum CA-125 levels in predicting pelvic or paraaortic lymph node metastasis in patients operated for epithelial ovarian cancer has been investigated. METHODS: 176 patients diagnosed with epithelial ovarian carcinoma after staging laparotomy between January 2002 and May 2010 were evaluated retrospectively. RESULTS: The mean, geometric mean, and median of preoperative serum CA-125 levels were 632,6, 200,29, and 191,5 U/mL, respectively. The cut-off value predicting lymph node metastases in the ROC curve was 71,92 U/mL, which is significant in logistic regression analysis (P = 0.005). The preoperative log CA-125 levels were also statistically significant in predicting lymph node metastasis in logistic regression analysis (P = 0.008). CONCLUSIONS: The tumor marker CA-125, which increases with grade independent of the effect of stage in EOC, is predictive of lymph node metastasis with a high rate of false positivity in Turkish population. The high false positive rate may obscure the predictive value of CA-125.

New insights into the pathogenesis of ovarian carcinoma: time to rethink ovarian cancer screening.

Recent discoveries about the pathogenesis of ovarian cancer have suggested that it can no longer be thought of as a single entity, but that the histologically defined ovarian cancer subtypes are different diseases, with different precursor lesions and distinct biomarker expression profiles. Most serous carcinomas probably arise from the fallopian tube. Clear cell and endometrioid carcinomas are associated with endometriosis and likely originate from ectopic endometrium. The focus of large ovarian cancer screening trials has been detection of macroscopic ovarian abnormalities by ultrasonography and detection of serum biomarkers associated with the most common (serous) subtype of ovarian cancer. The only completed and phase three randomized controlled trial failed to achieve the objective of reducing ovarian cancer mortality and was not able to demonstrate a stage migration effect of the screening. Future screening strategies have to incorporate our growing understanding of each subtype of pelvic (ovarian or fallopian tube) cancer, its organ of origin, and disease-specific biomarkers. We review how our current understanding of pathogenesis should prompt a reexamination of data from ovarian cancer screening studies and discuss potential designs for future screening strategies.

Prognostic impact of prechemotherapy serum levels of HER2, CA125, and HE4 in ovarian cancer patients.

OBJECTIVE: Human epididymis protein 4 (HE4) has attracted a lot of interest as a relatively novel biomarker for ovarian carcinoma. Research focus has been directed at HE4 as a diagnostic tool with potential for better triage of women with adnexal masses but the prognostic aspect of HE4 in ovarian cancer patients remains to be elucidated. The aim of the present study was to investigate the prognostic value of prechemotherapy serum HER2, cancer antigen 125 (CA125), and HE4 levels in ovarian cancer patients receiving standard combination chemotherapy. METHODS: Serum from 139 patients with newly diagnosed ovarian cancer was analyzed for HER2, CA125, and HE4 using enzyme-linked immunosorbent assay assays. Samples were collected just before first-line chemotherapy, and all patients were treated with carboplatin-paclitaxel combination chemotherapy. RESULTS: Increasing levels of serum HE4 (grouped into quartiles) was significantly associated with worse progression-free survival (PFS) (P < 10) and overall survival (P < 10). After adjustment in the Cox model, HE4 serum levels remained an independent prognostic parameter for PFS, with a hazard ratio of 1.77 (95% confidence interval, 1.03-3.04; P = 0.040) for patients with HE4 levels above the median compared with patients with HE4 levels below the median. The shorter PFS for patients with high levels of HE4 also translated into an independent significant difference in overall survival (hazard ratio, 3.17 [95% confidence interval, 1.41-7.10]; P = 0.005).Serum HER2 and CA125 levels did not demonstrate an independent prognostic value. CONCLUSIONS: High levels of serum HE4 is a strong and independent indicator of worse prognosis in epithelial ovarian cancer patients.

[Expression of B7-H1 protein in human pancreatic carcinoma tissues and its clinical significance].

BACKGROUND AND OBJECTIVE: B7-H1, a member of B7 family, is expressed in tumor cells and has emerged as an important immune modulator capable of suppressing host immunity by inhibiting T cells function. This study was to probe into the correlation between the expression level of B7-H1 protein in pancreatic carcinoma tissues and clinicopathological characteristics and prognosis. METHODS: The expression of B7-H1 was measured in 40 cases of pancreatic carcinoma tissues and 10 cases of normal corresponding paracarcinoma tissues by immunohistochemistry. The relationship between the expression level of B7-H1 and clinicopathological characteristics and survival was analyzed. RESULTS: The positive rate of B7-H1 was significantly higher in the tumor tissues [45.00% (18/40)] than in the normal corresponding paracarcinoma tissues [0(0/10)] (P<0.05); moreover, B7-H1 expression was significantly associated with the staging of tumor and preoperative serum CA19-9 level (P<0.05). The multivariate cox proportional hazards regression analysis of prognostic factors for overall survival and relapse-free survival showed that the expression of B7-H1 was an independent factor for poor prognosis. CONCLUSION: B7-H1 protein was expressed in human pancreatic carcinoma tissues, and was associated with the prognosis.

[Profiling of serum tumor markers in patients with epithelial ovarian carcinoma].

OBJECTIVE: To investigate whether the change of serum tumor markers profile after chemotherapy in epithelial ovarian carcinoma and evaluate the clinical significance. METHODS: The levels of CA(125), CA(19-9) and CP2 before and after initial surgery, during primary chemotherapy and follow-up were serially measured and analyzed retrospectively in 28 cases of recurrent epithelial ovarian carcinoma patients and 20 cases of primary chemo-resistant ovarian carcinoma patients from Jan 1999 to July 2007. According to whether the change of serum tumor markers profile, all the patients were divided into two groups: marker changed-group and marker un-changed group. The average follow up period was 25 months. RESULTS: (1) The changes of tumor marker profile were included the number and(or) types of markers, which included 13 cases (46%, 13/28) of the recurred cases and 9 cases (45%, 9/20) of the primary chemo-resistant cases. (2) For recurrent ovarian carcinoma changed tumor marker profile, the highest pathology type was serous histological type (77%, 10/13), while was mucinous histological type (4/9) for primary chemo-resistant patients. (3) For recurred patients, the median progression-free survival (PFS) and median overall survival (OS) in marker changed-group (22.2 and 60.0 months) were significantly longer than that in marker un-changed group (17.4, 46.0 months; P < 0.05). For primary chemo-resistant ovarian carcinoma patients, median OS in marker changed-group (15.9 months) was significantly shorter than that in marker un-changed group (25.0 months; P < 0.05). CONCLUSION: The profile of serum tumor makers in epithelial ovarian carcinoma may be changed after chemotherapy, which should be concomitantly determinate different serum tumor markers for monitoring the response to chemotherapy and follow-up of patients.

Mucinous cystadenocarcinoma arising in mature cystic teratoma ovary and associated pseudomyxoma peritonei: report of a case.

Pseudomyxoma peritonei (PMP) is most commonly associated with intra-abdominal spread of an appendiceal mucinous neoplasm and very rarely seen in cases of primary ovarian tumours. Mucinous adenocarcinoma arising in a mature cystic teratoma giving rise to PMP is even rarer. Extensive medlar search has revealed only nine cases; we are reporting tenth such case.

[Analysis of serum biomarkers of ovarian epithelial cancers based on 2-DE DIGE and MALDI TOF/TOF].

OBJECTIVE: To find new serum tumor markers for ovarian epithelial cancers by 2-DE DIGE and MALDI-TOF/TOF proteomic methods, in order to improve the diagnostic sensitivity and specificity. METHODS: Serum samples from 103 cases of ovarian epithelial cancers, 60 cases of healthy women, 63 cases of benign ovarian tumors and 63 cases of benign pelvic diseases were collected. Sera of 20 cases of ovarian epithelial cancers (A), 20 cases of ovarian benign tumors (B), 20 cases of pelvic benign diseases (C) and 20 cases of health control (D) were matched by age and pooled, respectively. After depletion of high abundance serum albumin and IgG, the samples were assayed by 2-DE DIGE. The test was repeated three times. Analysis with DeCyder software revealed significant differential protein spots which were identified by MAIDI-TOF/TOF. Western blot and ELISA were used to validate the candidate serum markers. RESULTS: 1) There were 41 proteins having significant differences between the groups. MAIDI-TOF/TOF successfully identified 28 proteins. Haptoglobin (Hp) was the most significantly up-regulated protein, and transferrin (Tf) was the most significantly down-regulated protein. 2) Western blot and ELISA proved that there were significant differences in Hp and Tf between ovarian epithelial cancers and normal controls (P = 0.000), between ovarian epithelial cancers and ovarian benign tumors (P = 0.000), between ovarian epithelial cancers and benign pelvic disease sera (P = 0.000). 3) CA125 + Hp + Tf combined detection of ovarian cancer had higher sensitivity and specificity than CA125, Hp or Tf detection alone. CONCLUSION: Hp and Tf are differently expressed in the sera of patients with ovarian epitheliual cancers. They can be used as serum biomarkers for ovarian epithelial cancers. CA125 + Hp + Tf combined detection may improve the sensitivity and specificity of diagnosis of ovarian epithelial cancers.

Pancreatic mucinous cyst adenocarcinoma producing CA 19-9. A case report.

CONTEXT: We herein present a rare case of a mucinous cystic neoplasm of the pancreas producing CA 19-9 and the clinical implications are discussed. CASE REPORT: A 35-year-old woman with no history of abdominal surgery presented at Saisei Kai Sendai Hospital with an upper abdominal distention. Abdominal CT showed a large lobulated cystic tumor at the pancreatic tail. No distant metastases were identified. The preoperative serum CA 19-9 level was 6,200 U/mL (reference range: 0-37 U/mL). A mucinous cystic neoplasm of the pancreas was diagnosed and elective surgery was performed. On laparotomy, a round tumor 15 cm in diameter was encountered in the upper left abdomen. No invasion of neighboring organs or the portal vein was apparent. The entire tumor was curatively resected with a distal pancreatectomy. The final histopathological analysis revealed mucinous cystadenocarcinoma with no invasive component. Immunohistochemical staining disclosed CA 19-9 expression within the tumor cells. The CA 19-9 level normalized rapidly postoperatively and, although a minor pancreatic fistula occurred, this was resolved conservatively. She was discharged on the 45th postoperative day with no sign of tumor relapse; her CA 19-9 level was within the normal range 20 months postoperatively. CONCLUSION: We present this rare case of a mucinous cystic neoplasm producing CA 19-9 and discuss the relevant literature. The CA 19-9 production in this tumor does not appear to be directly correlated to aggressive clinical behavior.

Epithelial ovarian tumors and CA125 in premenarchal girls.

PURPOSE: This is a review of our 18-year experience with premenarchal girls with epithelial ovarian tumors. Special attention was focused on the predictive value of CA125 serum levels. METHODS: Analysis of premenarchal patients with resected or biopsied ovarian masses from 1988 to 2005 was performed. Patient age, clinical presentation, operative procedures, histologic type of tumor, treatment and outcome were obtained. RESULTS: Six premenarchal girls (aged from 6 to 14 years) were surgically treated for epithelial tumors, representing 13% of all ovarian tumors at this age. Histological findings revealed cystadenoma in four girls, one with a mucinous borderline tumor and one with undifferentiated carcinoma. Tumor volume was higher than 400 cm3 in four girls. Sensitivity, specificity and positive predictive value of CA125 level for ovarian malignant epithelial tumors were 0.50, 0.50, and 0.33, respectively. The premenarchal girl with undifferentiated carcinoma in Stage III died after six months in spite of chemotherapy. CONCLUSION: Ovarian epithelial tumors in premenarchal girls show important growth potential and a relatively high malignancy rate with great influence of borderline neoplasms. CA125 is a tumor marker with low sensitivity and specificity for detection of epithelial ovarian malignancy in this age group.

[Detection of circulating hypermethylated tumor-specific RASSF1A DNA in ovarian cancer patients].

OBJECTIVE: To detect hypermethylated tumor-specific RASSF1A DNA in the circulation and its significance in ovarian cancers patients. METHODS: Methylation-specific polymerase chain reaction (MSP) was used to study the hypermethylation of RASSF1A in preoperative serum samples from 51 ovarian cancer patients. RESULTS: The RASSF1A gene was not methylated in peripheral blood samples from 51 normal patients and 51 patients with benign ovarian tumors. Hypermethylation of RASSF1A gene was found in circulating tumor-specific DNA in 43.1% of patients (22 out of 51 cases) with ovarian cancers (P < 0.05). There was no difference in hypermethylation of RASSF1A gene amongst various ovarian cancer subtypes (P < 0.05). On the other hand, hypermethylation of RASSF1A gene was more frequently encountered in stage III and IV than stage I and II tumors (P < 0.05). It was rarely seen in well and moderately differentiated groups, as compared with poorly differentiated group (P < 0.05). CONCLUSIONS: There is a higher frequency of RASSF1A hypermethylation in circulating tumor-specific DNA of ovarian cancer patients. RASSF1A has been postulated to play an important role as tumor suppressor gene and can be silenced by promoter hypermethylation. This methylation correlates with clinical stage and histopathologic grade. Such observation may carry diagnostic and prognostic implications when assessing ovarian tumors.

Detection of epithelial ovarian cancer using 1H-NMR-based metabonomics.

Currently available serum biomarkers are insufficiently reliable to distinguish patients with epithelial ovarian cancer (EOC) from healthy individuals. Metabonomics, the study of metabolic processes in biologic systems, is based on the use of (1)H-NMR spectroscopy and multivariate statistics for biochemical data generation and interpretation and may provide a characteristic fingerprint in disease. In an effort to examine the utility of the metabonomic approach for discriminating sera from women with EOC from healthy controls, we performed (1)H-NMR spectroscopic analysis on preoperative serum specimens obtained from 38 patients with EOC, 12 patients with benign ovarian cysts and 53 healthy women. After data reduction, we applied both unsupervised Principal Component Analysis (PCA) and supervised Soft Independent Modeling of Class Analogy (SIMCA) for pattern recognition. The sensitivity and specificity tradeoffs were summarized for each variable using the area under the receiver-operating characteristic (ROC) curve. In addition, we analyzed the regions of NMR spectra that most strongly influence separation of sera of EOC patients from healthy controls. PCA analysis allowed correct separation of all serum specimens from 38 patients with EOC (100%) from all of the 21 premenopausal normal samples (100%) and from all the sera from patients with benign ovarian disease (100%). In addition, it was possible to correctly separate 37 of 38 (97.4%) cancer specimens from 31 of 32 (97%) postmenopausal control sera. SIMCA analysis using the Cooman's plot demonstrated that sera classes from patients with EOC, benign ovarian cysts and the postmenopausal healthy controls did not share multivariate space, providing validation for the class separation. ROC analysis indicated that the sera from patients with and without disease could be identified with 100% sensitivity and specificity at the (1)H-NMR regions 2.77 parts per million (ppm) and 2.04 ppm from the origin (AUC of ROC curve = 1.0). In addition, the regression coefficients most influential for the EOC samples compared to postmenopausal controls lie around delta3.7 ppm (due mainly to sugar hydrogens). Other loadings most influential for the EOC samples lie around delta2.25 ppm and delta1.18 ppm. These findings indicate that (1)H-NMR metabonomic analysis of serum achieves complete separation of EOC patients from healthy controls. The metabonomic approach deserves further evaluation as a potential novel strategy for the early detection of epithelial ovarian cancer.

[Fluorodeoxiglucose F18 positron emission tomography imaging (F18FDG) for the assessment of rising levels of serum CA 19-9 in pancreatic mucinous cystadenocarcinoma. Report of one case]. / Estudio de imágenes PET con Flúor18-Desoxiglucosa (F18FDG) en evaluación de elevación de marcador tumoral CA 19-9 en paciente con cistoadenocarcinoma mucinoso de páncreas.

We report a 38 year old female patient with a pancreatic mucinous cystadenocarcinoma. She presented at the onset with a peritoneal rupture that required emergency surgery. Five months later, the patient was subjected to a segmental pancreatectomy and splenectomy. One year later, the patient had a serious gastric bleeding secondary to a gastric ulcer. Due to a persistent increase in her CA 19-9 levels, a Positron Emission Tomography (PET) functional imaging with fluorine 18-deoxyglucose (F18FDG) was done. It showed an intense focal hypermetabolism in the gastric wall reported as a secondary tumour location. The patient was subjected to a total gastrectomy and Roux en Y anastomosis, with a good outcome. The pathological study confirmed the presence of a metastasis of an adenocarcinoma in the gastric wall. The relative value of CA 19-9 markers and FDG PET in pancreatic and gastric carcinomas is discussed.

Significance of CA 125 serum level in discrimination between benign and malignant masses in the pelvis.

AIM: Our aim was to confirm that preoperative CA 125 serum level can be useful for discrimination between benign and malignant masses in the pelvis. METHODS: Preoperative CA 125 serum level was analyzed retrospectively in 121 patients who had surgery because of a malignant ovarian tumor and in 91 patients with benign masses in the pelvis. The cutoff serum level CA 125 between benign and malignant masses in the pelvis was 35 and 65 IU/ml. RESULTS: Of those patients with a malignant ovarian tumor, 65.3% had menopause whereas only 31.5% of those with a benign tumor did so. The average age of the patients with a malignant tumor was 54.2 years and of those with a benign tumor 46.8 years. The preoperative CA 125 serum level was higher than 35 IU/ml in 80.2% and higher than 65 IU/ml in 72.7% of all analyzed patients with a malignant tumor, whereas it was 23.9% and 9.8% respectively in patients with a benign mass. In early stage ovarian cancer disease (borderline stage, I/II) the preoperative CA 125 serum level was higher than 35 IU/ml in 67.8% and in 52.5% higher than 65 IU/ml. In advanced stages (III/IV), it was higher than 35 and 65 IU/ml in 96.1%. After therapy the CA 125 serum level dropped below 35 IU/ml in 70.8% and after three chemotherapy courses in 78.1%. A CA 125 level less than 35 IU/ml was achieved by therapy in 84.2% patients with an early stage disease (I/II) and in 62.1% in advanced stages (III/IV). The calculated sensitivity was 80.2% and negative 74.5% (CA 125 higher than 35 IU/ml) and 72.7%, 90.2%, 90.7%, 71.6% respectively (CA 125 higher than 65 IU/ml). CONCLUSION: . Preoperative determination of CA 125 is a very useful method to discriminate between benign and malignant masses in the pelvis.

[Ca 19-9 antigen in differentiation of pancreatic inflammatory and neoplastic tumors]. / Antygen Ca 19-9 w róznicowaniu guzów zapalnych i raka trzustki.

Difficulties in differentiation between inflammatory and neoplastic tumors of pancreas cause that the diagnostics based on image examinations requires the assessment of neoplastic markers. The aim of the paper is to evaluate the usefulness of Ca 19-9 in differentiation of inflammatory and neoplastic pancreatic tumors. Examinations were carried out on a group of healthy people (n = 32), patients with chronic pancreatitis (n = 32) and patients with carcinoma of exocrine part of pancreas (n = 32). In all examined patients Ca 19-9 concentration was measured by ELISA method. Ca 19-9 level in serum higher than the upper limit of range in reference group was noted in 46.9% of patients with chronic pancreatitis and in 90.6% in the group of patients with pancreatic carcinoma. Concentrations higher than 90 U/ml and 150 U/ml were noted in 31.3% and 15.6% patients with chronic pancreatitis respectively. Ca 19-9 concentration median in patients with pancreatic carcinoma (255.45 U/ml) was significantly higher (p < 0.001) in comparison to the level in patients with chronic pancreatitis (33.25 U/ml). Optimal dividing concentration was 150 U/ml. There was quite high percentage of false positive results. It made Ca 19-9 less useful in the differentiation between inflammatory and neoplastic pancreatic tumors. Ca 19-9 concentration measured in serum 37 U/ml was the dividing concentration in the diagnostics of chronic pancreatitis and pancreatic carcinoma. It seems to be not sufficient therefore in my opinion the level of 90 U/ml and even 150 U/ml should be considered as a dividing one.

The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19-9, Ca 125, Ca 15-3.

BACKGROUND: Differentiating between mucinous cystic tumors (MCTs) and serous cystic tumors (SCTs) can be a troubling diagnostic dilemma in pancreatology: when SCTs present in their macro-oligocystic form they must be resected because MCT cannot be ruled out, and some tumors considered benign are actually MCTs, which delays diagnosis and places patients at increased risk. Examination of preoperative serum tumor markers may help improve preoperative diagnosis. MATERIALS AND METHODS: The tumor markers CEA, Ca 19-9, Ca 125, and Ca 15-3 were examined in 157 patients with SCTs or MCTs. RESULTS: Positive CEA marker status is an indicator of an MCT, although sensitivity is low at 17%. Using three serum tumor markers (CEA, Ca 19-9, and Ca 125), 27% of MCTs were found to have two or more markers positive, compared to none for the SCTs. Sensitivity decreases to 13% for differentiating benign MCTs from benign SCTs but specificity remains 100%. CONCLUSIONS: In the differential diagnosis of SCTs vs. MCTs no reliable serum tumor marker exists which can diagnose SCTs and spare some patients unnecessary operations. Nonetheless, positive CEA serum marker status and or the presence of more than two positive serum markers (CEA, Ca 19-9, or Ca 125) indicates the presence of an MCT and can prevent delay in diagnosis.

Ovarian mucinous cystadenocarcinoma with virilization.

BACKGROUND: Ovarian neoplasms, other than sex cord--stromal tumors, are rare causes of hyperandrogenism. Only two cases of primary mucinous carcinomas associated with virilization have been reported. CASE: A 50-year-old female was referred to our clinic with a large pelvic mass. On examination she had significant facial hirsutism, clitoromegaly, and male pattern pubic hair growth. Serum levels of testosterone and dihydroepiandrosterone sulfate were elevated. A 30-cm, multilocular, solid and cystic, left ovarian mass was resected. Histology revealed moderately to poorly differentiated mucinous cystadenocarcinoma. The ovarian stroma contained florid proliferation of luteinized cells. The right ovary showed cortical stromal hyperplasia. Abnormal hormone values normalized 10 days postoperatively. CONCLUSION: We report a rare case of mucinous cystadenocarcinoma with virilization, review the literature, and discuss the mechanisms of hormone production by these tumors.

Role of tumor markers in the diagnosis of cystic and intraductal neoplasms.

Despite recent advances in imaging procedures, the correct diagnosis of cystic lesions of the pancreas is lacking in about one third of cases. Cyst fluid analysis can help in the differential diagnosis, particularly in patients with unilocular or paucilocular lesions, thus precluding unjustified resection in patients with benign cystic lesions of the pancreas. Although use of cystic fluid marker analysis is helpful in several situations, it is crucial to carefully evaluate the clinical context with appraisal of patient's demographics, clinical symptoms, and morphologic data. A multidisciplinary approach is advised and should improve the overall diagnostic performance and lead to better management strategies in patients presenting with such tumors of the pancreas.

CA 125 measurement and ultrasonography in borderline tumors of the ovary.

OBJECTIVES: Our goal was to perform an analysis of ultrasonographic characteristics and CA 125 levels in ovarian tumors of borderline malignancy. STUDY DESIGN: We performed a retrospective analysis of CA 125 levels and ultrasonographic parameters in 91 patients with borderline tumors. RESULTS: Serous tumors of borderline malignancy were associated with elevated CA 125 levels in 75% of patients before surgery (mean, 156 IU/mL) compared with 30% of mucinous tumors (mean, 28 IU/mL; P =.004). CA 125 was elevated in 35% of stage IA serous tumors (mean, 67 IU/mL) compared with 89% of tumors with spread beyond the ovary (mean, 259 IU/mL; P =.001). Mucinous tumors tended to be bigger (13.1 +/- 7 cm) on ultrasonography than serous tumors (9.3 +/- 6.2 cm, P =.016). Mucinous tumors were multilocular in half the patients and contained papillations in 40% of the patients. Serous tumors were multilocular in 30% of the patients but presented with solid or papillary patterns in 78% of the patients (P =.001). A resistance index of <0.4 was found in 36% of mucinous tumors and half the cases of serous tumors. In 13% of patients, ultrasonographic characteristics were compatible with a simple cyst only, including 1 patient with microinvasion and 1 patient with stage IIIB disease. Sensitivity of gray-scale ultrasonography was 87%, that of CA 125 measurement was 62%, and that of flow was 55%. At least 1 diagnostic test result was abnormal in 93% of patients, 2 were abnormal in 69% of patients, and all 3 were abnormal in 21% of patients. CONCLUSIONS: A high proportion of borderline tumors of the ovary, particularly of the serous type, were associated with elevated CA 125 levels and abnormal ultrasonographic characteristics, although some tumors presented as simple cysts.